Safety of reduced or absent antithrombotic therapy after left atrial appendage closure in patients affected by hereditary hemorrhagic telangiectasia and atrial fibrillation

Pepe, Martino; Suppressa, Patrizia; Giuliano, Antonio; Nestola, Palma Luisa; Bortone, Alessandro Santo; Cillis, Emanuela De; Acquaviva, Tommaso; Forleo, Cinzia; Moscarelli, Marco; Lenato, Gennaro Mariano

doi:10.23736/s2724-5683.20.05474-2

Cited by 5 publications

(2 citation statements)

References 36 publications

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“…In those patients for whom the net benefit of OAC is considered to be unfavourable, alternative approaches like LAAC should be adopted 21 . Two small case series reported good immediate-and medium-term results of LAAC performed in patients with HHT and NVAF, with effective protection both for bleeding and systemic thromboembolism 20,22 .…”

Section: Age-related Macular Degenerationmentioning

confidence: 99%

Percutaneous left atrial appendage closure: beyond the classic indications

Guérios¹,

Chamié²

2023

AsiaIntervention

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Percutaneous left atrial appendage closure (LAAC) has proven to be an effective alternative to oral anticoagulation (OAC) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). International guidelines traditionally recommend LAAC for NVAF patients at high thromboembolic risk and contraindication to or at high risk for OAC. However, there are many other clinical situations in which this procedure may also be beneficial. This paper discusses the potential role of LAAC in specific haemorrhagic diseases (cerebral amyloid angiopathy, age-related macular degeneration, hereditary haemorrhagic telangiectasia, and Moyamoya disease), after left atrial appendage (LAA) electrical isolation, in cases of persistent thrombus inside the LAA, in end-stage renal disease and in special groups of patients for whom low compliance and persistence to OAC may be anticipated.

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Section: Age-related Macular Degenerationmentioning

confidence: 99%

Percutaneous left atrial appendage closure: beyond the classic indications

Guérios¹,

Chamié²

2023

AsiaIntervention

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“…A further common indication is atrial fibrillation, which complicates high cardiac output states in the setting of HHT hepatic AVMs, particularly when anaemia develops [43]. Left atrial appendage closure is increasingly performed for HHT patients unable to tolerate the usually recommended anticoagulation [44][45][46]. In addition to treatment (therapeutic) doses, anticoagulants are often indicated at lower (prophylactic) doses, for example, peri-operatively or in hospitalized, acutely ill medical patients [47,48].…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenomic Considerations for Anticoagulant Prescription in Patients with Hereditary Haemorrhagic Telangiectasia

McCarley,

Murphy,

Thompson

et al. 2023

JCM

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Hereditary haemorrhagic telangiectasia (HHT) is a vascular dysplasia that commonly results in bleeding but with frequent indications for therapeutic anticoagulation. Our aims were to advance the understanding of drug-specific intolerance and evaluate if there was an indication for pharmacogenomic testing. Genes encoding proteins involved in the absorption, distribution, metabolism, and excretion of warfarin, heparin, and direct oral anticoagulants (DOACs) apixaban, rivaroxaban, edoxaban, and dabigatran were identified and examined. Linkage disequilibrium with HHT genes was excluded, before variants within these genes were examined following whole genome sequencing of general and HHT populations. The 44 genes identified included 5/17 actionable pharmacogenes with guidelines. The 76,156 participants in the Genome Aggregation Database v3.1.2 had 28,446 variants, including 9668 missense substitutions and 1076 predicted loss-of-function (frameshift, nonsense, and consensus splice site) variants, i.e., approximately 1 in 7.9 individuals had a missense substitution, and 1 in 71 had a loss-of-function variant. Focusing on the 17 genes relevant to usually preferred DOACs, similar variant profiles were identified in HHT patients. With HHT patients at particular risk of haemorrhage when undergoing anticoagulant treatment, we explore how pre-emptive pharmacogenomic testing, alongside HHT gene testing, may prove beneficial in reducing the risk of bleeding and conclude that HHT patients are well placed to be at the vanguard of personalised prescribing.

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